Correlation between lumbar spinal performance and clinical outcomes after spine treatment in LBP patients

• Applicant: Professor Adamantios Arampatzis, Ph.D.
• Subject Area: Orthopaedics, Traumatology, Reconstructive Surgery
• Term: since 2021
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 439742772

Systematic reviews show that the effects of most non-surgical treatments for chronic low back pain (LBP) patients are rather limited and that only physical exercise interventions lead to consistent treatment success in terms of LBP prevalence and associated disability. Nevertheless, there is no evidence that a particular type of exercise intervention is more effective than others. This leads to the concept that exercise interventions should focus on targeted subgroups of LBP patients and should thus address specific factors of LBP in order to provide efficient, subject-specific treatment. We therefore plan to design an innovative exercise intervention based on random/irregular functional perturbation training and to apply this therapy in asymptomatic and chronic LBP patients who have neuromuscular control deficits in spine stability. Our strategy in the perturbation-based intervention aims at increasing the amount of trunk muscle activation during exercise to improve muscle strength and increase the need of the neuromotor system to process sensory signals and generate appropriate motor commands. SP4 aims to gain a better understanding of (1) how functional perturbations affect spine alignment, motion and mechanics in asymptomatic and chronic LBP patients, (2) how asymptomatic participants and chronic LBP patients use specific muscle activation patterns to stabilise the spine in the presence of perturbations, (3) the effects of a perturbation-based intervention on the regulation of spine alignment, motion and mechanics in asymptomatic and chronic LBP patients and (4) how a perturbation-based intervention that is tailored to a homogeneous subgroup could provide a more efficient care of chronic LBP than a conventional intervention focusing on muscle strengthening. For these purposes we will adopt three work packages (WP). In WP1, we will assess the neuromuscular control of spine stability in 100 asymptomatic and 100 LBP patients during mechanically-induced perturbations using nonlinear time series analysis and the so-called muscle synergy concept investigating aims (1) and (2). In WP2 and WP3, we will apply two exercise interventions (perturbation-based and muscle strength intervention) in 272 asymptomatic and 200 LBP patients with poor neuromuscular control. Treatment effects on spine alignment, motion, muscle activation patterns, LBP and disability as well as psychological outcomes (SP5) and spinal load (SP2) will be assessed before and directly after the interventions as well as six weeks, six months and 12 months later in order to investigate aims (3) and (4). We expect that the perturbation-based intervention will provide superior improvements in movement coordination, mechanics and LBP as well as longer follow-up retention of the achieved improvements.

• DFG Programme: Research Units
• Subproject of: FOR 5177: The Dynamics of the Spine: Mechanics, Morphology and Motion towards a comprehensive Diagnosis of Low Back Pain
• Co-Investigators: Professorin Dr. Lena Fleig; Professor Dr. Hendrik Schmidt